The Henry Ford Health System (HFHS) is an integrated, not-for-profit health care organization in Metro Detroit. The corporate office is at One Ford Place, in Midtown Detroit, Michigan. Henry Ford established the health system in 1915, and it is currently run by a 17-member board of trustees. Henry Ford Health System also owns the health insurance company Health Alliance Plan.
Atopic dermatitis (AD) is a chronically relapsing, complex skin disease characterized mainly by skin lesions and itch. The first-line treatment for patients with AD includes topical therapy, such as topical corticosteroids (TCS) and topical calcineurin inhibitors (TCI). Long-term use of topical medications can be burdensome for patients, and despite these burdens, topicals remain a frequent treatment option, not only in patients with mild-to-moderate disease, but also as concomitant therapy in patients with moderate-to-severe disease. Lebrikizumab is a novel monoclonal antibody that binds with high affinity and slow off-rate to interleukin (IL)-13, thereby blocking the downstream effects of IL-13 with high potency. This review focuses on the use of topical medications in the lebrikizumab ADvocate1 2 monotherapy trials and ADjoin long-term extension study in the context of similar trials for interleukin (IL)-13/IL-4 inhibitors. In the first 16 weeks of the ADvocate1 and ADvocate2 monotherapy clinical trials, topical therapy was not permitted, and patients receiving topicals were considered nonresponders in the primary analysis. In the subsequent 36-week maintenance period, concomitant therapy was permitted at investigator discretion; however, most patients did not use TCS (TCS use: 11.9
BACKGROUND:Sickle cell disease is characterized by chronic hemolytic anemia and recurrent severe vaso-occlusive crises. Ristoglogene autogetemcel (risto-cel) includes autologous CD34+ hematopoietic stem and progenitor cells that have been base-edited to target the HBG1 and HBG2 promoters and inhibit BCL11A binding without altering BCL11A expression, yielding a switch in hemoglobin production from sickle hemoglobin (HbS) to antisickling fetal hemoglobin (HbF). METHODS:In this phase 1-2 study, we enrolled patients 12 to 35 years of age with sickle cell disease who had had at least four severe vaso-occlusive crises in the 2 years before enrollment. After myeloablative conditioning with pharmacokinetically guided administration of busulfan, patients received a single infusion of risto-cel (at a dose of ≥3.0×106 viable CD34+ cells per kilogram of body weight). The primary efficacy end point was freedom from severe vaso-occlusive crises for 12 consecutive months, starting later than 60 days after the last red-cell transfusion. This interim analysis was unplanned; here, we describe safety, editing, engraftment, and hemoglobin production and the number of severe vaso-occlusive crises starting later than 60 days after the last red-cell transfusion. RESULTS:A total of 31 patients received risto-cel and were followed for a mean of 6.6 months (range, 0.3 to 20.4). A median of one cycle (range, one to five) was required for stem-cell collection. Neutrophil engraftment occurred at a median of 17.5 days, and platelet engraftment at a median of 19 days. One patient died from idiopathic pneumonia syndrome. All 31 patients had at least one adverse event, 27 (87%) had an adverse event of grade 3 or higher, and 12 (39%) had a serious adverse event. At 6 months, the mean fraction of on-target edited alleles in peripheral blood was 67.4%, the mean HbF as a fraction of total hemoglobin was more than 60%, and the HbS as a fraction of total hemoglobin was less than 40% (among 13 patients); these levels were maintained throughout follow-up. No investigator-reported severe vaso-occlusive crises occurred later than 60 days after the last red-cell transfusion. CONCLUSIONS:Treatment with risto-cel was followed by rapid engraftment and durable expression of HbF and reduction in HbS. These data support further investigation of risto-cel to treat sickle cell disease. (Funded by Beam Therapeutics; BEACON ClinicalTrials.gov number, NCT05456880.).
OBJECTIVES:To evaluate whether neighbourhood socioeconomic deprivation, measured by the Area Deprivation Index (ADI), is associated with cancer-specific mortality (CSM) in patients with non-muscle-invasive bladder cancer (NMIBC). PATIENTS AND METHODS:We retrospectively reviewed patients with NMIBC (T stage <2, node-negative, non-metastatic) from Michigan Cancer Surveillance Program (2004-2019). ADI national percentiles were assigned based on residential census block groups and stratified into quartiles, with the fourth quartile (ADI 75-100) being the most deprived. Cumulative incidence functions compared CSM between quartiles, and competing-risk regression analysis assessed the association between ADI and CSM after adjusting for covariates. RESULTS:Among 19 722 patients (92.2% non-Hispanic White; median [interquartile range] age 72 [64-80] years; 76.7% male), most resided in metropolitan areas (81%) and 61% were married. Overall, 8.5%, 26.4%, 34.9%, and 30.2% of patients were in the first, second, third, and fourth ADI quartile, respectively. At 10 years, the cumulative incidence of CSM was 7.3%, 7.9%, 8.7%, and 9.7% across the first-fourth quartiles, respectively (P = 0.002). At the competing risk analysis, each 25-point increase in ADI was associated with a 6% higher hazard of CSM (95% confidence interval 1.01-1.12; P = 0.032). Older age, higher T stage, unmarried status, and Medicaid insurance were independently associated with greater CSM. CONCLUSIONS:Higher ADI was associated with increased CSM in our cohort. Evaluating socioeconomic context in NMIBC care may inform follow-up and therapy and, potentially, influence progression and mortality.
BACKGROUND:Penile cancer is a rare malignancy influenced by socioeconomic factors. The Area Deprivation Index (ADI) is a validated measure of neighborhood-level socioeconomic disadvantage, and its association with penile cancer stage at presentation has not been studied. This study aimed to assess the relationship between the ADI and advanced-stage disease at diagnosis in penile cancer. METHODS:A retrospective study was conducted with the Michigan Department of Health and Human Services database of patients aged ≥18 years with penile squamous cell carcinoma from 2004 to 2019. Advanced-stage disease was defined as pathological T stage ≥2, pathological evidence of nodal metastasis, or reported presence of distal metastasis. ADI scores were compared to the national median value. Univariable and multivariable logistic regression analyses were performed to assess the association between the ADI and advanced disease after adjusting for relevant covariates. RESULTS:Among 353 patients (median age, 72 years; 84.4% White), the median ADI score was 69. Patients were stratified into two groups on the basis of the national median; 76% were in the high-ADI group. Black patients were more prevalent in the higher ADI group (15.3% vs. 2.4%; p = .003). Advanced-stage penile cancer was more frequent in the higher ADI group (49.3% vs. 36.5%; p = .04). In multivariable analysis, each 10-point increase in the ADI was associated with 1.16-fold increased odds of advanced-stage disease (95% CI, 1.04-1.29; p = .02). CONCLUSIONS:Greater neighborhood-level socioeconomic deprivation is associated with advanced-stage disease at penile cancer diagnosis. These findings emphasize the role of social determinants in disease presentation, and may guide targeted interventions in disadvantaged populations.
Chronic pain is common, complex, undertreated, and linked with lower quality of life. The primary care setting provides an opportunity to standardize screening for chronic pain and distress and facilitate early intervention via integrated psychological treatment. This study describes the use of a digital pain and distress screener to improve identification of those who could benefit from integrated psychological treatment to manage chronic pain in primary care. An electronic pain and distress screening tool was implemented in an academic internal medicine clinic at an urban hospital. Data regarding screening completion, percentage of positive screens, and number of integrated psychology referrals were pulled from the electronic medical record. 1,676 unique pain and distress screenings were completed between March 2024 and January 2025. Forty-three percent of patients screened positive (n = 837). Thirty-nine patients were referred for integrated psychological treatment and 20 completed at least one visit. Older adult patients completed the digital pain and distress screener at similar rates to other digital screenings with positive screening rates similar to the known prevalence of comorbid pain and distress. Referral rates were low though a high proportion of referrals began treatment. With modifications to workflow, the pain and distress screening could facilitate early and effective intervention.
